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Thrombolytics in pulmonary embolism

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https://www.readbyqxmd.com/read/29197610/thromboembolic-risk-of-endovascular-intervention-for-lower-extremity-deep-venous-thrombosis
#1
Philip Lindsey, Angela Echeverria, Mun J Poi, Jesus Matos, Carlos F Bechara, Mathew Cheung, Peter H Lin
INTRODUCTION: This study evaluated the risk of thromboembolism during endovascular interventions in patients with symptomatic lower extremity deep vein thrombosis (DVT) METHODS: Clinical records of all patients who underwent endovascular interventions for symptomatic lower extremity DVT from 2001 to 2017 were retrospectively analyzed using a prospectively maintained database. Only patients who received an IVC filter were included in the analysis. Trapped intra-filter thrombus was assessed for procedural-related thromboembolism...
November 29, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29175415/multiple-overlapping-systematic-reviews-facilitate-the-origin-of-disputes-the-case-of-thrombolytic-therapy-for-pulmonary-embolism
#2
Nicoletta Riva, Livia Puljak, Lorenzo Moja, Walter Ageno, Holger Schünemann, Nicola Magrini, Alessandro Squizzato
OBJECTIVE: To explore disagreements in multiple systematic reviews (SRs) assessing the benefit-to-harm ratio of thrombolytic therapy in patients with intermediate-risk pulmonary embolism (PE). STUDY DESIGN AND SETTING: MEDLINE, EMBASE, CDSR and DARE were searched up to April 14, 2016. We included SRs and guidelines that evaluated thrombolytic therapy, compared to anticoagulation alone, in intermediate-risk PE. We calculated pooled risk ratio (RR) and absolute risk difference (RD), with interquartile range (IQR), for all-cause mortality, recurrent PE and major bleeding...
November 21, 2017: Journal of Clinical Epidemiology
https://www.readbyqxmd.com/read/29157528/catheter-based-embolectomy-for-acute-pulmonary-embolism-devices-technical-considerations-risks-and-benefits
#3
REVIEW
Wissam A Jaber, Michael C McDaniel
A significant number of patients with high-risk pulmonary embolism have contraindications to thrombolytic therapy. Catheter-based therapy may be helpful and consists of a multitude of catheters and techniques, some old and some new. Although there are few data supporting the use of any of these techniques, there has been a recent rise in interest and use of catheter-based pulmonary embolectomy. This text describes the contemporary devices used in pulmonary embolism treatment, discusses their challenges, and proposes some future directions...
January 2018: Interventional cardiology clinics
https://www.readbyqxmd.com/read/29157527/catheter-directed-therapy-for-pulmonary-embolism-patient-selection-and-technical-considerations
#4
REVIEW
Bedros Taslakian, Akhilesh K Sista
Acute pulmonary embolism (PE) is the third most common cause of death among hospitalized patients. Treatment escalation beyond anticoagulation therapy is necessary in patients with cardiogenic shock and may be of benefit in select normotensive patients with right heart strain. Percutaneous catheter-based techniques (catheter-directed mechanical thrombectomy, clot maceration, and/or pharmacologic thrombolysis) as an alternative or adjunct to systemic thrombolysis can rapidly debulk central clot in patients with shock...
January 2018: Interventional cardiology clinics
https://www.readbyqxmd.com/read/29157526/systemic-thrombolysis-for-pulmonary-embolism-evidence-patient-selection-and-protocols-for-management
#5
REVIEW
Hafeez Ul Hassan Virk, Sanjay Chatterjee, Partha Sardar, Chirag Bavishi, Jay Giri, Saurav Chatterjee
Acute pulmonary embolism presents a clinical challenge for optimal risk stratification. Although associated with significant morbidity and mortality at the population level, the spectrum of presentation in an individual patient varies from mild symptoms to cardiac arrest. Treatment options include anticoagulation, systemic thrombolysis, catheter-based interventions, and surgical embolectomy. In this article, an attempt is made to optimally identify patients who, based on available evidence, may benefit from systemic thrombolytic therapy...
January 2018: Interventional Cardiology Clinics
https://www.readbyqxmd.com/read/29128608/a-retrospective-comparison-of-survivors-and-non-survivors-of-massive-pulmonary-embolism-receiving-veno-arterial-extracorporeal-membrane-oxygenation-support
#6
Bennet George, Marc Parazino, Hesham R Omar, George Davis, Maya Guglin, John Gurley, Susan Smyth
INTRODUCTION: While the optimal care of patients with massive pulmonary embolism (PE) is unclear, the general goal of therapy is to rapidly correct the physiologic derangements propagated by obstructive clot. Extracorporeal membrane oxygenation (ECMO) in this setting is promising, however the paucity of data limits its routine use. Our institution expanded the role of ECMO as an advanced therapy option in the initial management of massive PE. The purpose of this project was to evaluate ECMO-treated patients with massive PE at an academic medical center and report shortterm mortality outcomes...
November 8, 2017: Resuscitation
https://www.readbyqxmd.com/read/29122207/-massive-pulmonary-embolism-when-medical-treatment-is-not-enough
#7
B Gerardin, M Glorion, A Rodriguez, C Garcia, F Stephan, D Fabre, O Mercier, P Brenot, E Fadel
Emergency bedside veno-arterious ECMO implantation can be the only saving gesture in the suspicion of acute massive pulmonary embolism leading to haemodynamic failure, even before CT-scan imaging. Once the massive pulmonary embolism is confirmed it is possible to undergo surgical or percutaneous pulmonary thrombectomy, when thrombolytic therapy is contraindicated.
November 6, 2017: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/29077155/utility-of-biochemical-markers-and-rvd-lvd-ratio-in-acute-pulmonary-embolism-risk-classification-in-emergency-department
#8
M O Ay, N Kozaci, M Avci, B Cekic, N Cerit, O Keskin, A Celik
OBJECTIVE: We aimed to determine the efficacy of troponin I, D-dimer, and lactate levels and right ventricular diameter (RVD)/left ventricular diameter (LVD) ratio on pulmonary computed tomography angiography (PCTA) in the risk classification of patients who were diagnosed with acute pulmonary embolism (APE) in Emergency Department (ED). PATIENTS AND METHODS: Patients who were diagnosed as having APE by PCTA in ED were included in this retrospective study. Patients were grouped as high-risk (undergoing cardiopulmonary resuscitation or given thrombolytic therapy), moderate-risk (with non-high-risk and positive ECO findings) and low risk (others)...
October 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/29070745/incidence-characteristics-and-management-of-venous-thromboembolism-in-japan-during-2011
#9
Satoshi Ota, Akimasa Matsuda, Yoshito Ogihara, Norikazu Yamada, Mashio Nakamura, Takuya Mori, Masayuki Hamada, Takao Kobayashi, Masaaki Ito
BACKGROUND: This study aimed to determine the incidence, characteristics and management of venous thromboembolism (VTE) in Japan during 2011.Methods and Results:A retrospective study assessed responses to a questionnaire regarding treating newly diagnosed VTE at all admitting hospitals throughout Japan during 2011. More individuals were diagnosed with VTE than ever before, with 16,096 cases of diagnosed pulmonary embolism (PE) and 24,538 cases of diagnosed deep vein thrombosis (DVT)...
October 25, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/29037581/pulmonary-embolism-due-to-exogenous-estrogen-intoxication
#10
Caner Çelik, Murat Carus, Fatih Büyükcam
OBJECTIVE: Pulmonary embolism is a relatively common clinical presentation of venous thromboembolism, which develops in relation to acute pulmonary arterial occlusion mostly caused by thrombi of the lower limbs. CASE REPORT: 29year old female admitted to emergency department with pulmonary thromboembolism due to an ingestion of 17 Diana 35 pills (2 mg cyproterone acetate and 0.035mg ethinyl estradiol) in a suicide attempt without any previously known predisposing factors...
August 18, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29034035/surgical-embolectomy-for-acute-pulmonary-thromboembolism
#11
REVIEW
Ikuo Fukuda, Kazuyuki Daitoku
Acute pulmonary thromboembolism is a catastrophic event, especially for hospitalized patients. The prognosis of pulmonary thromboembolism depends on the degree of pulmonary arterial occlusion. The mortality of massive pulmonary embolism is reportedly as high as 25% without cardiopulmonary arrest and 65% with cardiopulmonary arrest. In patients with unstable hemodynamics due to pulmonary thromboembolism, surgical pulmonary embolectomy is indicated for patients with a contraindication to thrombolysis, failed catheter therapy, or failed thrombolysis...
June 25, 2017: Annals of Vascular Diseases
https://www.readbyqxmd.com/read/29029712/advanced-cardiopulmonary-support-for-pulmonary-embolism
#12
REVIEW
Oren Friedman, James M Horowitz, Danny Ramzy
Management of high-risk pulmonary embolism (PE) requires an understanding of the pathophysiology of PE, options for rapid clot reduction, critical care interventions, and advanced cardiopulmonary support. PE can lead to rapid respiratory and hemodynamic collapse via a complex sequence of events leading to acute right ventricular failure. Importantly, reduction in pulmonary vascular resistance must be accomplished either by systemic thrombolytics, catheter directed thrombolytics, endovascular clot extraction, or surgical embolectomy...
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29029710/systemic-thrombolysis-for-pulmonary-embolism-who-and-how
#13
REVIEW
Victor F Tapson, Oren Friedman
Anticoagulation has been shown to improve mortality in acute pulmonary embolism (PE). Initiation of anticoagulation should be considered when PE is strongly suspected and the bleeding risk is perceived to be low, even if acute PE has not yet been proven. Low-risk patients with acute PE are simply continued on anticoagulation. Severely ill patients with high-risk (massive) PE require aggressive therapy, and if the bleeding risk is acceptable, systemic thrombolysis should be considered. However, despite clear evidence that parenteral thrombolytic therapy leads to more rapid clot resolution than anticoagulation alone, the risk of major bleeding including intracranial bleeding is significantly higher when systemic thrombolytic therapy is administered...
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/29029706/pulmonary-embolism-in-2017-how-we-got-here-and-where-are-we-going
#14
REVIEW
Geno J Merli
In the 1970s, both the Urokinase Pulmonary Embolism and Urokinase-Streptokinase Pulmonary Embolism trials began the quest to develop thrombolytic therapy for the treatment of acute massive and submassive pulmonary embolism (PE). The goals of these studies were the immediate reduction in clot burden, restoration of hemodynamic stability, and improved survival. Major bleeding became the major barrier for clinicians to employ these therapies. From 1980s to the present time, a number of studies using recombinant tissue-type plasminogen activator for achieving these same above outcomes were completed but major bleeding continued to remain an adoption barrier...
September 2017: Techniques in Vascular and Interventional Radiology
https://www.readbyqxmd.com/read/28954974/a-case-of-cerebral-embolism-with-a-large-thrombus-in-the-left-atrium-and-a-recurrence-of-thrombus-in-the-left-atrium-after-the-maze-procedure
#15
Masafumi Arakawa, Takashi Shimoyama, Noriko Matsumoto, Satoshi Suda, Jiro Kurita, Kazumi Kimura
A 67-year-old woman developed weakness of the entire left side of the body and disturbance of consciousness, and was admitted to our hospital. She had atrial fibrillation (AF) on arrival at the hospital. Diffusion weighted magnetic resonance imaging showed high intensity area in the right basal ganglia, and magnetic resonance angiography showed occlusion of the right internal carotid artery (ICA). Thrombolytic therapy with intravenous tissue plasminogen activator (IV tPA) was administered 225 minutes after onset, and endovascular procedure also performed...
October 27, 2017: Rinshō Shinkeigaku, Clinical Neurology
https://www.readbyqxmd.com/read/28945166/echocardiographic-assessment-with-right-ventricular-function-improvement-following-ultrasound-accelerated-catheter-directed-thrombolytic-therapy-in-submassive-pulmonary-embolism
#16
Charles Doheny, Lorena Gonzalez, Stanley M Duchman, Joseph Varon, Carlos F Bechara, Mathew Cheung, Peter H Lin
Introduction The objective of this study was to evaluate the efficacy of ultrasound-accelerated catheter-directed thrombolytic therapy in patients with submassive pulmonary embolism. Methods Clinical records of 46 patients with submassive pulmonary embolism who underwent ultrasound-accelerated catheter-directed pulmonary thrombolysis using tissue plasminogen activator, from 2007 to 2017, were analyzed. All patients experienced clinical symptoms with computed tomography evidence of pulmonary thrombus burden...
January 1, 2017: Vascular
https://www.readbyqxmd.com/read/28944131/ultrasound-assisted-catheter-directed-thrombolysis-of-acute-pulmonary-embolism-a-review-of-current-literature
#17
REVIEW
Muhammad A Mangi, Hiba Rehman, Vikas Bansal, Omer Zuberi
Pulmonary embolism continues as a very common and also presumably life-threatening disorder. For affected individuals with intermediate- as well as high-risk pulmonary embolism, catheter-based revascularization procedures have developed a possible substitute for systemic thrombolysis or for surgical embolectomy. Ultrasound-assisted catheter-directed thrombolysis is an innovative catheter-based approach; which is the main purpose of the present review article. Ultrasound-assisted catheter-directed thrombolysis is much more efficacious in reversing right ventricular dysfunction as well as dilatation in comparison to anticoagulation alone in individuals at intermediate risk...
July 19, 2017: Curēus
https://www.readbyqxmd.com/read/28891082/thrombolysis-for-massive-pulmonary-embolism-in-pregnancy
#18
Mojdeh S Heavner, Min Zhang, Chelsea E Bast, Lindsey Parker, Rachel F Eyler
Pregnant women are at high risk for venous thromboembolism, including pulmonary embolism (PE), given expected changes in coagulation, fibrinolysis, and venous blood flow. In fact, PE is the leading cause of maternal death in the United States. Nonpregnant patients who develop PE with hypotension or show signs of deterioration after anticoagulation receive thrombolytics as a standard of care. Pregnant women, however, have been excluded from clinical trials with thrombolytics, and all data available in this population are published as case reports or case series...
September 11, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28887730/an-exploration-of-the-reflow-technique-for-the-fabrication-of-an-in-vitro-microvascular-system-to-study-occlusive-clots
#19
Yang Li, Chuer Pan, Yunfeng Li, Eugenia Kumacheva, Arun Ramachandran
Embolic ischemia and pulmonary embolism are health emergencies that arise when a particle such as a blood clot occludes a smaller blood vessel in the brain or the lungs, and restricts flow of blood downstream of the vessel. In this work, the reflow technique (Wang et al. Biomed. Microdevices 2007, 9, 657) was adapted to produce a microchannel network that mimics the occlusion process. The technique was first revisited and a simple geometrical model was developed to quantitatively explain the shapes of the resulting microchannels for different reflow parameters...
September 8, 2017: Biomedical Microdevices
https://www.readbyqxmd.com/read/28882336/comparison-of-in-hospital-outcomes-and-readmission-rates-in-acute-pulmonary-embolism-between-systemic-and-catheter-directed-thrombolysis-from-the-national-readmission-database
#20
Shilpkumar Arora, Sidakpal S Panaich, Nitesh Ainani, Varun Kumar, Nileshkumar J Patel, Byomesh Tripathi, Purav Shah, Nirali Patel, Sopan Lahewala, Abhishek Deshmukh, Apurva Badheka, Cindy Grines
There are sparse comparative data on in-hospital outcomes and readmission rates in patients with acute pulmonary embolism (PE) who receive systemic thrombolytics versus catheter-directed thrombolysis (CDT). The study cohort was derived from the National Readmission Database 2013 to 2014, subset of the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality. Systemic and CDT were identified using appropriate International Classification of Diseases, 9th Revision, Clinical Modification codes...
November 1, 2017: American Journal of Cardiology
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